AB0941 Osteoarticular Tuberculosis: Clinical and Therapeutic Features (About 42 Cases)

Abstract

BackgroundOsteoarticular tuberculosis (OAT) is still common and represents 2-5% of all tuberculosis and 11 to 15% of extrapulmonary tuberculosis. It rather affects spine and weight-bearing joints.ObjectivesThe objective of our study was to describe the clinical, biological, radiological and therapeutic aspects of osteoarticular tuberculosis.MethodsThis is a retrospective study of 42 cases of OAT collected in the Department of Rheumatology over a period of 16 years [1998-2014].ResultsOur population consists of 23 men and 19 women. The mean age was 52 years [18-83]. Comorbidities noted were diabetes in 4 cases and chronic renal failure in 2 cases. Tuberculous contact was found in 4 cases. Alteration of the general state and night sweats were found in 5 cases. Tuberculous spondylodiscitis was diagnosed in 29 patients which interested lumbar spine in 16 case, thoracic spine in 10 cases and cervical spine in 3 cases. An extra-spinal bone tuberculosis was observed in 13 cases touching knees in 5 cases, hip in 5 cases, wrist in one case, sacroiliac in one case and greater trochanter in one case. A multifocal osteoarticular tuberculosis was observed in 3 patients. Symptoms were dominated by inflammatory pain found in 34 cases. Psoas abscess was noted in 3 cases, paravertebral abscess in 9 cases and multiple abscesses in one case. A biological inflammatory syndrome was present in 35 patients. Plain radiographs were abnormal in 23 cases. They objectified disc space narrowing in 18 cases and erosion of the vertebral endplates in 3 cases. CT was performed in 12 cases and MRI in 22 cases having confirmed bone disease in all cases. The tuberculin test was positive in 7 cases. The search of koch bacillus in the sputum was positive in 4 cases, in the urine in 2 cases and in joint fluid in 11 cases. An histological confirmation was obtained in 11 cases. The tuberculous origin was retained in other cases based on clinical and radiological data. All patients were put on anti tuberculosis treatment with a total treatment duration of 12 months on average. Surgical drainage of abscesses was performed in 5 cases.ConclusionsOAT still common in Tunisia because of the endemicity of tuberculosis. There are still severe forms of the disease. Isolation of Mycobacterium tuberculosis is difficult. The diagnosis is often based on a beam of arguments.Disclosure of InterestNone declared